The collection of the information on this form is authorized under the Ministry of Health Act, R.S.O. 1990, c.M.26, section 6(1)(4) to determine eligibility for assistance under the Assistive Devices Program. For further details concerning this collection, please contact the Senior Program Coordinator, Assistive Devices Program, 7th Floor, 5700 Yonge Street, Toronto M2M 4K5, telephone (416) 327-8804, 1-800-268-6021, facsimile (416) 327-8192.
The Insulin Syringes for Seniors Program is intended to assist diabetic seniors, 65 years or older, to purchase needles and syringes for insulin administration.
Applicants must have a valid Health Card and require insulin injections on
a daily basis. If you have recently turned 65 and are not registered with the
Benefit (ODB) Program or you are over 65 but have just started taking insulin
should ask your pharmacist to give you a note indicating you take insulin injections.
Send the note with the completed application.
The Program does not cover the cost of needles and syringes for residents of chronic care hospitals or persons who reside in Long Term Care facilities. These persons are provided with needles and syringes during their stay in these facilities.
Persons who reside in other residential facilities such as Retirement Homes or Private Boarding Homes are eligible to receive the grant.
Once your first application has been approved, Assistive Devices Program (ADP) will automatically send you a payment every 12 months.
ADP has the ability to confirm with the Ontario Health Insurance Plan (OHIP) that you are still a resident of Ontario and that your Health Number is valid. If something does not match the health card database, your payment will not be made. Therefore, if you change your surname or address, it is extremely important that you notify ADP immediately, in writing, at the address below. Also, if you receive a new Health card, call ADP with your new number.
Please print all of the required information in the places indicated. Incomplete applications cannot be processed. It is an offence to knowingly provide incorrection information on this form. Facsimile or photocopies of this form are not acceptable.
Once complete, mail your application to:
Assistive Devices Program
7th floor, 5700 Yonge Street
Toronto ON M2M 4K5
Telephone: 416 327-8804 (Toronto), 1 800 268-6021 (Toll-free), or 1 800 387-5559 (TDD) if you have any questions about the Insulin Syringes for Seniors Program.
1429-67 (2009/10) © Queen’s Printer for Ontario, 2009
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